AUTOMATED BENEFIT CALCULATION SYSTEM

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1 Employees Manual Revised September 30, 2011 Title 14 Chapter B Appendix AUTOMATED BENEFIT CALCULATION SYSTEM Appendix

2 TABLE OF CONTENTS Chapter B Automated Benefit Calculation System Appendix Revised July 10, 2015 SYSTEM CODING INSTRUCTIONS...1 TD01: Case Information...1 TD01: Section I. Identification...4 TD01: Section II. Name and Address...36 TD02: Section III. Food Assistance...43 TD02: Section IV. and Refugee...49 RSCF: Food Assistance Monthly Resources...53 RSCA: Monthly Resources...54 TD05: Section V. Medical...55 RSCM: Medical Resources...65 RSCS: Facility, Waiver, and State Supplementary Assistance Resources...67 TD03: Section VII. Person Information...68 TD06: Section IX. Special Issuances...93 BCW1 & BCW1: Case Information BCW2: Individual Income Information TD04: Section VI. Foster Care and Subsidized Adoption NOTICE CODES Primary Headers Approval Cancellation Change Conservator/Guardian Released Denial Denial of Unnecessary Application Corrective Payments Presumptive Eligibility Special Payment Denials Special Payment (One-Time Approval) Special Payment (Ongoing) Food Assistance Application Pending Food Assistance Application: 30-Day Delay Due to Client Food Assistance Limited Use Lump Sum Medicaid: Automatic Redetermination Medicaid: Extended or Transitional Coverage Medicaid: MEPD Review Page 1

3 TABLE OF CONTENTS Chapter B Automated Benefit Calculation System Appendix Revised July 10, 2015 Page Medicaid: MEPD Reopening Payment Adjustment Reinstatement and Reopening Remain Denied Remain Canceled Case Reason Messages Appeal Decision CMAP or MKSN , Medicaid, and State Supplementary Assistance EAC Ineligibility Period (3 months) EAC Ineligibility Period (6 months) EAC Ineligibility Period (Application Denial) Hardship Exemption Limited Benefit Plan Special Payment Cancellation Food Assistance: Benefit Changes Food Assistance: Cancellation or Denial Food Assistance: Continuing Failure to Comply Food Assistance: Failure to Comply Food Assistance: Income Food Assistance: Missed Appointment Food Assistance: Resources Mass Changes Medicaid, Medically Needy, and State Supplementary Assistance Medicaid and State Supplementary Assistance Medicaid and State Supplementary Assistance Income...204b Medicaid and State Supplementary Assistance Resources Medicaid: MEPD Cancellation...210d Medicaid: MEPD Denial...210d Medicaid: Suspension of Inmates...210e Medicaid: Waiver Denial Multiple Programs Refugee Person Reason Messages Appeal Decision Hardship Exemption

4 TABLE OF CONTENTS Chapter B Automated Benefit Calculation System Appendix Revised July 10, 2015 Page Limited Benefit Plan Food Assistance Food Assistance: Continuing Failure to Comply with Work Registration Food Assistance: IPV Disqualifications Food Assistance Work Registration Medicaid and State Supplementary Assistance Multiple Programs QMB, SLMB, QDWP, and E-SLMB Refugee Notice Override Notice Override EBT EBT Adjustment Agree EBT Adjustment Disagree EBT Adjustment Retailer Initiated EBT Aging Reference Chart ACTION CODES Facility and Waiver Codes Positive Negative System-Generated Codes WIFS MESSAGES WORKER ACTION MESSAGES BENEFITS HISTORY INFORMATION ISSUANCE VERIFICATION SYSTEM AUTOMATIC TICKLER MESSAGES ABBREVIATIONS USED ON WORKER ACTION REPORT CODING GUIDES

5 SYSTEM CODING INSTRUCTIONS TD01 CASE Chapter B Automated Benefit Calculation System Appendix Revised April 2, 2010 SYSTEM CODING INSTRUCTIONS This section contains coding instructions for data entered on the ABC system. SCREEN/ NUMBER FIELD NAME/ DESCRIPTION TD01: Case Information PRGM USE WORKER INSTRUCTIONS TD01 C.I. 1 CASE ALL The case number consists of a six-character serial number, a two-character FBU, a one-character MULT, and a one-character check digit. Check new cases to see if the case name has been assigned a case number. If no case number exists, then the system assigns the next sequential number to the case. TD01 C.I. 0 ENT RSN Entry Reason ALL When an entry is made on the case information line, an entry reason is required. Valid codes are: A C H Application Approval, no application Immediate release TD01 C.I. 2 CO County Office ALL Enter the two-digit code corresponding to the county where the worker is located. Valid codes are: 00 Hoover Bldg. 17 Cerro Gordo *01 Adair 18 Cherokee *02 Adams *19 Chickasaw *03 Allamakee 20 Clarke 04 Appanoose 21 Clay *05 Audubon *22 Clayton 06 Benton 23 Clinton 07 Black Hawk 24 Crawford 08 Boone 25 Dallas 09 Bremer *26 Davis 10 Buchanan 27 Decatur 11 Buena Vista 28 Delaware 12 Butler 29 Des Moines *13 Calhoun 30 Dickinson 14 Carroll 31 Dubuque 15 Cass 32 Emmet *16 Cedar 33 Fayette 1

6 SYSTEM CODING INSTRUCTIONS TD01 CO Revised June 24, 2003 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 CO 34 Floyd *67 Monona *35 Franklin 68 Monroe *36 Fremont 69 Montgomery *37 Greene 70 Muscatine *38 Grundy 71 O Brien *39 Guthrie *72 Osceola 40 Hamilton 73 Page *41 Hancock *74 Palo Alto 42 Hardin 75 Plymouth 43 Harrison *76 Pocahontas 44 Henry 77 Polk *45 Howard 78 Pottawattamie *46 Humboldt 79 Poweshiek *47 Ida *80 Ringgold *48 Iowa *81 Sac 49 Jackson 82 Scott 50 Jasper *83 Shelby 51 Jefferson 84 Sioux 52 Johnson 85 Story 53 Jones 86 Tama 54 Keokuk *87 Taylor 55 Kossuth 88 Union 56 Lee *89 Van Buren 57 Linn 90 Wapello *58 Louisa 91 Warren *59 Lucas 92 Washington *60 Lyon *93 Wayne 61 Madison 94 Webster 62 Mahaska 95 Winnebago 63 Marion 96 Winneshiek 64 Marshall 97 Woodbury 65 Mills *98 Worth *66 Mitchell 99 Wright * These offices are staffed on a less-than-full-time basis. Do not transfer cases to these counties. Transfer the case to the designated full-time office. 2

7 SYSTEM CODING INSTRUCTIONS TD01 WKR Chapter B Automated Benefit Calculation System Appendix Revised July 25, 2008 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 C.I. 3 WKR Worker Number ALL Enter the four-character number assigned to the worker who is responsible for case maintenance. The first character represents the office. The second character indicates the program. The third character designates the unit supervisor. The fourth character identifies the worker. C M A 2 C M A 2 Office Program Supervisor Worker Valid codes are: Office A Administrative office C Central office, central office in a county, or the Income Maintenance Customer Call Center (county 78) D Service area E East office G Glenwood Resource Center (county 65) J Cherokee MHI (county 18) K Clarinda MHI (county 73) L Independence MHI (county 10) M Mt. Pleasant MHI (county 44) or hawk-i office N North office P Pioneer Columbus office (county 77) R Refugee Service Center S South Office W Woodward Resource Center (county 08) Program A Income Maintenance Customer Call Center C Income Maintenance Customer Call Center E Income Maintenance Unit at hawk-i or Income Maintenance Customer Call Center M Income maintenance F Income Maintenance Customer Call Center R Income Maintenance Customer Call Center S Social services 3

8 SYSTEM CODING INSTRUCTIONS TD01 INFO. Revised May 30, 2008 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 C.I. 3 WKR Worker Number ALL Unit Supervisor A-Z, or O only for transfer of cases. Worker 1-9 A-Z, or O only for transfer of cases. TD01 C.I. 4 INFO. Priority Information ALL Enter messages and reminder information pertaining to the case. Quality Assurance also uses this field to write messages to the worker, e.g., cancellation of warrant. TD01: Section I. Identification TD01 I. 15 ENT RSN Entry Reason ALL Enter the code that corresponds with case entry reason. This field is completed for entries in Identification, Section I. Valid codes are: A C H Application Approval, no application Immediate release TD01 I. 16 AID Program Codes ALL Enter the aid type under which cash assistance, State Supplementary Assistance, facility payments, and client participation will be calculated. Some aid types are valid only in the AID field. Others are valid in both the AID field and the AID field. For Medicaid there must be an entry in both the AID field and the AID field. Aid types that are valid in the AID field will roll to the AID field if no entry is made in the AID field. SSI-related aid types for people who are disabled are automatically converted to the corresponding aid type for the aged at month end of the month before the month of the recipient s sixty-fifth birthday. The effective month of the aid type change is the month after the sixty-fifth birthday. For example, aid type 60-0 becomes aid-type 10-0 at October month end, effective December 1, if the recipient becomes 65 during November. 4

9 SYSTEM CODING INSTRUCTIONS TD01 AID Chapter B Automated Benefit Calculation System Appendix Revised November 15, 2013 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 16 AID Program Codes Some aid types are listed on the following table more than once. Abbreviations used in the table are: A Aged B Blind D Disabled Family Investment Program FA Food Assistance Program ICF/ID Intermediate care facility for persons with an intellectual disability IHHRC In-home health-related care IV-E Title IV-E (-related foster care and adoption assistance) MEPD Medicaid for employed people with disabilities MHI Mental health institute MIYA Medicaid for independent young adults NF Nursing facility PMIC Psychiatric medical institution for children RCA Refugee Cash Assistance Program RCF Residential care facility RMA Refugee Medical Assistance Program SSI Supplemental Security Income Program FOOD ASSISTANCE 09-0 FA, adult, not public assistance 09-1 FA, family, not public assistance FAMILY INVESTMENT PROGRAM 30-0, regular 30-2, money management (obsolete) 30-4, nonparental 32-8, protective payee, guardian, or conservator (obsolete) 33-8, two-parent, with a protective payee, guardian, or conservator (obsolete) 35-0, two-parent, when there are two active parents of a common child who are both referred to PROMISE JOBS and one parent is the head of household or case name. 5

10 SYSTEM CODING INSTRUCTIONS TD01 AID Revised November 15, 2013 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 16 AID Program Codes REFUGEE RESETTLEMENT PROGRAM 06-0 RCA or RMA or both, family 06-1 RCA or RMA or both, adult 06-3 RMA, eligible for RCA but requests no grant STATE SUPPLEMENTARY ASSISTANCE Dependent Person 14-6 SSI-A, receives SSI, with dependent 24-6 SSI-B, receives SSI, with dependent 64-6 SSI-D, receives SSI, with dependent Family-Life Home 10-0 SSI-A, family-life home 60-0 SSI-D, family-life home In-Home Health-Related Care 14-1 SSI-A, IHHRC 64-1 SSI-D, IHHRC Residential Care Facility 13-4 SSI-A, RCF, eligible for SSI payment 13-5 SSI-A, RCF, income exceeds SSI limit 63-4 SSI-D, RCF, eligible for SSI payments 63-5 SSI-D, RCF, income exceeds SSI limit Supplement for Medicare and Medicaid Eligibles 60-M MEPD 13-6 SSI-A, NF, income exceeds SSI maximum (300% group) 63-6 SSI-D, NF, income exceeds SSI maximum (300% group) 64-5 Disabled, NF or SNF level of care 73-1 Skilled nursing care (300% group) 73-2 SSI, state resource center ICF/ID, income exceeds SSI maximum (300% group) 73-3 SSI, community-based ICF/ID income exceeds SSI maximum (300% group) 73-4 Hospital care, income exceeds SSI maximum (no facility calculation) 73-5 SSI-A, MHI, income exceeds SSI maximum (300% group) 6

11 SYSTEM CODING INSTRUCTIONS TD01 AID Chapter B Automated Benefit Calculation System Appendix Revised August 4, 2006 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 16 AID Program Codes FMAP-RELATED ICAID Family Medical Assistance Program (FMAP) 30-8 Family Medical Assistance Program Transitional or Extended Medicaid 37-0 FMAP, transitional or extended Medicaid Child Medical Assistance (CMAP) 37-2 Child Medical Assistance Medicaid for Independent Young Adults (MIYA) 37-6 MIYA Mothers and Children (MAC) 92-0 Pregnant women, infants, and children Eligible for FMAP or FMAP-Related Medicaid if Not in Medical Institution 37-7, MHI or PMIC, care payment only 39-0, nursing facility, care payment only Automatic Redetermination 38-0 FMAP, automatic redetermination IowaCare 60-E 200% group for people ages 19 to P 300% group for pregnant and newborns ICALLY NEEDY 37-E Medically Needy, FMAP-related, CMAP-related, and SSI-related SSI-RELATED ICAID Receiving SSI 14-0 Receives SSI-A or mandatory supplement 64-0 Receives SSI-D or mandatory supplement Eligible for SSI But Not Receiving Benefits 14-3 Eligible for SSI-A; receives no cash benefits 64-3 Eligible for SSI-D; receives no cash benefits 7

12 SYSTEM CODING INSTRUCTIONS TD01 AID Revised September 16, 2005 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 16 AID Program Codes SSI-RELATED ICAID Qualified Medicare Beneficiary, Qualified Disabled Working Persons, Specified Low- Income Medicare Beneficiary, Expanded Specified Low-Income Medicare Beneficiary 90-0 Aged 90-2 Disabled Automatic Redetermination 14-4 SSI-A, automatic redetermination 64-4 SSI-D, automatic redetermination Other Coverage Groups 14-2 Aged: People ineligible for SSI or SSA because of Social Security COLA (503 medical) Widowed people ineligible for SSI or SSA due to 1984 Social Security actuarial change People ineligible for SSI or SSA due to child s Social Security disability benefits Widowed people ineligible for SSI or SSA who do not have Medicare Part A and who are ineligible for SSI or SSA because of the receipt of Social Security benefits 64-2 Disabled: People ineligible for SSI or SSA because of Social Security COLA (503 medical) People ineligible for SSI or SSA due to child s Social Security disability benefits Widowed people ineligible for SSI or SSA due to 1984 Social Security actuarial change Widowed people ineligible for SSI or SSA because of the receipt of Social Security benefits who do not have Medicare Part A 8

13 SYSTEM CODING INSTRUCTIONS TD01 AID Chapter B Automated Benefit Calculation System Appendix Revised November 15, 2013 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 16 AID Program Codes SSI-RELATED ICAID 64-7 Medicaid for Kids with Special Needs 60-M Medicaid for employed people with disabilities ICAID FACILITIES Nursing Facility 13-0 SSI-A, NF, would be eligible for SSI payment if at home 13-1 SSI-A, NF, eligible for SSI payment 13-6 SSI-A, NF, income exceeds SSI maximum (300% group) 63-0 SSI-D, NF, would be eligible for SSI payment if at home 63-1 SSI-D, NF, eligible for SSI payment 63-6 SSI-D, NF, income exceeds SSI maximum (300% group) 39-0 FMAP, NF, care payment Skilled Nursing Care 73-1 Skilled nursing care ICF/ID 63-7 SSI, community-based ICF/ID, eligible for SSI if at home 63-8 SSI, community-based ICF/ID, eligible for SSI payment 73-3 SSI, community-based ICF/ID, income exceeds SSI maximum (300% group) 63-2 SSI, state resource center ICF/ID, eligible for SSI payment if at home 63-3 SSI, state resource center ICFID, eligible for SSI payment 73-2 SSI, state resource center ICF/ID, income exceeds SSI maximum (300% group) SSI Hospital 73-4 Hospital care, income exceeds SSI maximum (no facility calculation) 9

14 SYSTEM CODING INSTRUCTIONS TD01 AID Revised November 15, 2013 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 16 AID Program Codes Mental Health Institute or PMIC 13-7 SSI-A, MHI, eligible for SSI payment 13-8 SSI-A, MHI, SSI-eligible if at home 73-5 SSI-A, MHI, income exceeds SSI limit (300% group) 37-7 FMAP or SSI child or adult, MHI or PMIC 37-7 Adult involuntarily committed to MHI ICAID HOME- AND COMMUNITY-BASED WAIVERS AIDS/HIV Waiver 63-6 SSI-D related 300%, NF level of care 13-6 SSI-A related 300%, NF level of care %, skilled level of care 73-4 SSI-related 300%, hospital level of care 37-E Medically Needy, over 300%, hospital level of care Brain Injury Waiver 73-3 ICF/ID level of care %, skilled nursing level of care %, SSI-D related, NF level of care Children s Mental Health Waiver 37-7 FMAP-related or SSI-related children Elderly Waiver 13-6 NF level of care 73-1 SNF level of care Health and Disability Waiver 64-5 Disabled, NF or SNF level of care 73-3 ICF/ID level of care Intellectual Disabilities Waiver 73-3 ICF/ID level of care Physical Disability Waiver %, nursing facility level of care 63-1 SSI-D, at nursing facility level of care %, skilled nursing level of care 10

15 SYSTEM CODING INSTRUCTIONS TD01 AID Chapter B Automated Benefit Calculation System Appendix Revised February 29, 2008 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 16 AID Program Codes SYSTEM-GENERATED AID TYPES 80-0 Medical transportation payment made to client (fund code 1, 2, A, C, or R) 80-1 Medical transportation payment made to public transportation provider (fund code 1, 2, A, C, or R) 80-2 Medical transportation payment made other than to client or public transportation provider (fund code 1, 2, A, C, or R) 80-3 Medical transportation payment made to client (fund code 3 or 4) 80-4 Medical transportation payment made to public transportation provider (fund code 3 or 4) 80-5 Medical transportation payment made other than to client or public transportation provider (fund code 3 or 4) FOSTER CARE AND SUBSIDIZED ADOPTION (used on SSNI screen only; see 14-C, SSNI = Medicaid Eligibility File) Entered by field staff 40-9 Medical only, state-only no grant Not entered by field staff 02-1 Foster family care, refugee 02-3 Group care, refugee 02-7 Independent living, refugee 02-8 Shelter care, refugee 40-1 Foster family care, regular 40-3 Group care, regular 40-7 Independent living, regular 40-8 Shelter care, regular 41-1 SSI, blind, foster family care 41-3 SSI, blind, group care 41-7 SSI, blind, independent living 41-8 SSI, blind, shelter care 11

16 SYSTEM CODING INSTRUCTIONS TD01 AID Revised September 11, 2009 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 16 AID Program Codes 42-1 IV-E foster family care 42-3 IV-E group care 42-8 IV-E shelter care 42-9 IV-E, medical only, out-of-state child placed in Iowa 43-1 Foster family care, payment only 43-3 Group care, payment only 43-7 Independent living, payment only 43-8 Shelter care, payment only 46-1 Subsidized adoption maintenance, not IV-E 46-2 Subsidized adoption maintenance, IV-E 46-3 Presubsidy, not IV-E 46-4 Presubsidy, IV-E 46-5 Medical only, receives subsidy from another state 47-0 Subsidized foster home 47-1 Nonsubsidized foster care program 48-1 SSI, disabled, foster family care 48-3 SSI, disabled, group care 48-7 SSI, disabled, independent living 48-8 SSI, disabled, shelter care TD01 I. 17 AID CHG DT Date of Case Aid Type Change ALL Enter in MMDDYY format the effective date of the case aid type change. The day is always 01. Entry is required when the aid type changes. TD01 I. AID MEPD MN FAC WAV ST SUPP Enter the aid type under which Medicaid eligibility will be granted. In some cases, the AID and AID fields will contain the same aid type. In others, they will be different. If no aid type is entered, the AID field will roll to the AID field when the AID field entry is a valid AID type. Aid Types Valid in AID Field Only

17 SYSTEM CODING INSTRUCTIONS TD01 AID Chapter B Automated Benefit Calculation System Appendix Revised February 20, 2009 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 AID Aid Types Valid in Both AID and AID Fields I E E 60-M 60-P TD01 I. CHG DT Date of Medical Aid Type Change MN FAC WAIV ST SUPP Enter in MMDDYY format the effective date of the medical aid type change. The day is always 01. Entry is required when the aid type changes. TD01 I. 33 CASE REC: RE Case Record Tracking Reason ALL Enter the code for the reason the case folder (current volume) is sent to another office. Codes are: AD Audit CA Corrective action specialist review CO Central office review FR Federal review LR Legal review ME Management evaluation review OT Other QC Quality control review RO Regional office review RT Case folder is returned TR Transfer to another county (optional entry) Entries update TRAC, on line. 13

18 SYSTEM CODING INSTRUCTIONS TD01 CASE REC: LOC Revised July 10, 2015 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 34 CASE REC: LOC Case Record Tracking Location ALL Enter the code that indicates where the case folder is sent. Entries update TRAC, on line. No location entry is required for LR, OT, or RT reason codes. Valid codes are: 00 Central Office The county to which the folder is sent for AD, CA, ME, QC or TR reasons. R1-R5 The region to which the folder was sent for FR, CA or RO review. TD01 I. 35 CASE REC: DATE Case Record Date ALL The date the folder was sent in MM/DD/YY format. Not required for reason code RT. The system generates the date when it is not entered. Entries update TRAC on line. TD01 I. 20 MR DEMAND 1: MO Month for Which a Form Is to Be Printed in the Daily Process FA REF IACARE Enter the number for the month in which the report form would normally be mailed (the month before the month in the END CERT or NEXT REV field or, for the Medicaid Review, before the review month). Valid codes are: 01 January 05 May 09 September 02 February 06 June 10 October 03 March 07 July 11 November 04 April 08 August 12 December TD01 I. 21 MR DEMAND 1: CD Demand Code 1 FA REF IACARE If the MR DEMAND 1 MO field is entered, enter the code that identifies the type of report form requested. The system will determine the appropriate message to be printed on the form. Valid codes are: 4 or FMAP-related medical review (RRED) 5 FA recertification (RRED) Note: If a client requests replacement of the recertification form, enter code 5, not 9. 14

19 SYSTEM CODING INSTRUCTIONS TD01 MR DEMAND 1: CD Chapter B Automated Benefit Calculation System Appendix Revised July 10, 2015 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 21 MR DEMAND 1: CD Demand Code 1 6 review and FA recertification (RRED) 9 Client request (no message) Note: Enter 9 only if the client requests a form in a month in which no other form has been sent. M Medicaid review Q Quarterly report for transitional Medicaid; valid for current period or month only TD01 I. 22 MR DEMAND 1 CYC Demand Cycle Code 1 FA REF Enter C only when the client is due to return the demanded RRED in the monthly cycle. (If this field is used, do not use the demand due date field.) If no due date is required, leave blank. Do not enter this field for the Medicaid Review form. For an in-cycle report form, the due date printed on the form changes to the next month s due date after the current due date has past. TD01 I. 23 MR DEMAND 1 DT Demand Due Date 1 FA REF IACARE Enter the out-of-cycle date that the demanded RRED or Medicaid Review is due to be returned by the client, using four digits (MMDD). If no due date is required, leave blank. (If this field is used, do not use the demand cycle code field.) 15

20 SYSTEM CODING INSTRUCTIONS TD01 MR DEMAND 2 MO Revised July 10, 2015 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 24 MR DEMAND 2 MO Month for Which a Form Is to Be Printed in the Daily Process FA REF IACARE Enter the number for the month in which the report form would normally be mailed (the month before the month in the END CERT or NEXT REV field or, for the Medicaid Review, before the review month). Valid codes are: 01 January 05 May 09 September 02 February 06 June 10 October 03 March 07 July 11 November 04 April 08 August 12 December TD01 I. 25 MR DEMAND 2 CD Demand Code 2 FA REF IACARE Enter if the MR DEMAND 2 MO field is entered. Enter the code that identifies the type of report form requested. The system will determine the appropriate message to be printed on the form. Valid codes are: 4 or FMAP-related medical review (RRED) 5 FA recertification (RRED) Note: If a client requests replacement of the recertification form, enter code 5, not 9. 6 review and FA recertification (RRED) 9 Client request (no message) Note: Enter only if no other form has been sent in the month. M Medicaid review Q Quarterly report for transitional Medicaid; valid for current period or month only TD01 I. 26 MR DEMAND 2 CYC Demand Cycle Code 2 FA REF Enter C only when the client is due to return the demanded RRED in the monthly cycle. (If this field is used, do not use the demand due date field.) If no due date is required, leave blank. Do not enter this field for the Medicaid Review form. For an in-cycle report form, the due date printed on the form changes to the next month s due date after the current due date has past. 16

21 SYSTEM CODING INSTRUCTIONS TD01 MR DEMAND 2 DT Chapter B Automated Benefit Calculation System Appendix Revised July 10, 2015 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 27 MR DEMAND 2 DT Demand Due Date 2 FA REF IACARE Enter the out-of-cycle date that the demanded RRED or Medicaid Review is due to be returned by the client, using four digits (MMDD). If no due date is required, leave blank. (If this field is used, do not use the demand cycle code field.) TD01 I. 28 LI Language Indicator ALL Enter S if the household speaks only Spanish. TD01 II. 52 PHONE Client Telephone Number ALL Enter the three-digit area code and the seven-digit telephone number for the client. TD01 I. 44 CO RES Resident County ALL Enter the two-digit number for the county in which the client resides. Enter 00 to indicate out-of-state placement. If no entry is made, the system generates an on-line edit that requires an entry before you leave TD01. TD01 I. 30 SERV WRK Service Referral To ALL If applicable, enter the four-character worker number that identifies the service worker. If the specific worker is not known, enter CS00. TD01 I. 31 SERV NEED Service Referral Need ALL This is a three-character field. The first two characters describe the service to which the client is referred. Valid codes are: Code Service 01 Adoption services 02 Court-ordered custody investigation 03 Subsidized adoption 04 Adult residential care 05 Family-life home 17

22 SYSTEM CODING INSTRUCTIONS TD01 SERVICE NEED Revised February 23, 2007 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 31 SERV NEED Service Referral Need Code Service 09 Child protection 10 Family-centered service 14 Child care, half-day, group child-care home 15 Child care, half-day, center 16 Child care, half-day, family child-care home 17 Child care, half-day, in-home 18 Adult day care 19 Shelter care 25 Family planning 26 Independent living 27 Foster family care 29 Foster group care 30 Adult residential services 31 Juvenile court-related services 34 Supervised apartment services (adult) 39 Adult support service 47 Dependent adult abuse 51 Work activity 52 Sheltered workshop 57 Transportation 60 Service management 61 Child care, full day, group child-care home 62 Child care, full day, center 63 Child care, full day, family child-care home 64 Child care, full day, in-home 80 Medicaid case management 98 In-home health care The third character identifies the person or agency requesting the service. Valid codes are: Code Person or Agency A J Z Client household Person within DHS Other 18

23 SYSTEM CODING INSTRUCTIONS TD01 VOC REH Chapter B Automated Benefit Calculation System Appendix Revised February 24, 1998 SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 32 VOC REH Vocational Rehabilitation Worker Number This number is entered by Quality Assurance. TD01 I. 43 SCHOOL School District REF Enter 4-digit code that indicates the school district in which the assistance unit lives. Valid codes are: 01 ADAIR 0792 Bridgewater-Fontanelle 2673 Greenfield Comm Orient-Macksburg 02 ADAMS 1431 Corning Comm. School 5328 Prescott Community 03 ALLAMAKEE 0135 Allamakee Comm Eastern Allamakee 5310 Postville Community 04 APPANOOSE 1071 Centerville Comm Moravia Comm. School 4518 Moulton-Udell Comm. 05 AUDUBON 0414 Audubon Comm. School 2151 Exira Comm. School 06 BENTON 0576 Belle Plaine Comm Benton Comm. School 4806 Norway Comm. School 5967 Shellsburg Comm Urbana Comm. School 6660 Vinton Comm. School 19

24 SYSTEM CODING INSTRUCTIONS TD01 SCHOOL Revised February 24, 1998 Iowa Department of Human Services Chapter B Automated Benefit Calculation System Appendix SCREEN/ NUMBER FIELD NAME/ DESCRIPTION PRGM USE WORKER INSTRUCTIONS TD01 I. 43 SCHOOL School District 07 BLACK HAWK 1044 Cedar Falls Comm Dunkerton Comm Hudson Comm. School 3501 La Porte City Comm Waterloo Comm. 08 BOONE 0729 Boone Comm. School 2570 Grand Comm. School 3942 Madrid Comm. School 4878 Odgen Comm. School 6561 United Community 09 BREMER 1719 Denver Comm. School 3186 Janesville Consolidated 5238 Plainfield Comm Sumner Comm. School 6471 Tripoli Comm. School 6762 Wapsie Valley School 6840 Waverly-Shell Rock 10 BUCHANAN 1963 East Buchanan Comm Independence Comm Jesup Comm. School 11 BUENA VISTA 0072 Albert City-Truesdale 0171 Alta Comm Newell-Providence 6048 Sioux Rapids-Rembrandt 6219 Storm Lake Comm. 12 BUTLER 0153 Allison-Bristow 0279 Aplington Comm Clarksville Comm Dumont Comm. School 2664 Greene Comm. School 4671 New Hartford Comm Parkersburg Comm. 20

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